Ethical questions from science: Debate rages over impregnating women in their 50s

In Toronto, owing to the marvels of artificial procreation, a mother who qualifies for the seniors menu at Denny’s is raising a 19-month-old toddler.

The now 57-year-old postmenopausal woman’s unnatural conception — made possible using eggs purchased from a much younger donor — raised eyebrows when reported last year, even among doctors in a field that routinely pushes the biological limits of childbearing.

But now, as more older women pursue motherhood, Canada’s fertility doctors and ethicists are asking: when is old too old?

Egg donation has made it possible for virtually any woman with a functioning uterus, regardless of age, to carry a baby using eggs from a younger woman.

But a new Canadian guideline under development for women of “advanced maternal age” seeking infertility treatments will explore whether it’s safe — or ethical — to impregnate a woman well into her 50s, or beyond.

There are no legal upper age limits for egg donation recipients in Canada. The nation’s for-profit fertility industry says women aged 50 to 60 who conceive using donor eggs (or, if the egg is fertilized, donor embryos) can achieve “acceptable outcomes,” based on the limited science that exists, although they are at slightly higher risk of pre-eclampsia (rapid and potentially life-threatening high blood pressure) and gestational diabetes, especially so after age 55.

In the U.S., the American Society for Reproductive Medicine says egg or embryo donation should be discouraged after 55, and “discouraged or denied” in any woman over 50 with underlying health issues that could increase pregnancy-related risks.

Canada’s fertility doctors, however, say that ultimately they might not agree on any specific age cutoff.

“It’s a complicated topic,” said Dr. Jeffrey Roberts, president-elect of the Canadian Fertility and Andrology Society and medical director for the Pacific Centre for Reproductive Medicine in Burnaby, B.C.

He’s aware of one case in B.C. involving a couple in their 60s that wants to have a baby using an egg donor and surrogate mother.

Theoretically, both parents could enter a nursing home before their child starts high school.

Dalhousie University bioethicist and feminist philosopher Angel Petropanagos says the argument against older mothers, especially, runs deep. Critics have described postmenopausal mothers as “gross, unnatural and selfish,” Petropanagos wrote last year on the website, Impact Ethics (impactethics.ca ) — “bad” mothers who are flaunting “the social norms surrounding motherhood — where the good mother is construed as young, beautiful, energetic and selfless.”

“There’s a lot more social disapproval, it seems, against older mothers than older fathers,” Petropanagos said in an interview.

Others argue advances in assisted conception are simply levelling the reproductive playing field between men and women, she said. In an era of reproductive freedom, the argument holds, why should women be denied what has long been the purview of men, if the science now makes pregnancy past the natural dictates of menopause possible?

This much is true: while still small, the number of babies born to women 50 and older in Canada is increasing. From 2010 to 2012, there were 145 live births to women aged 50 and older, compared with 15 such births from 2001 to 2003, according to Statistics Canada.

No one can say absolutely that each of those births involved a donor egg. However, there are very few “own egg” pregnancies reported past the age of 47, even when helped along with in vitro fertilization, said Dr. Ari Baratz, chair of the Ontario Medical Association’s reproductive biology section. By the time a woman reaches 44, greater than 95 per cent of her remaining eggs are abnormal.

Baratz is a reproductive endocrinologist and infertility specialist at CReATe Fertility Centre in Toronto — the same clinic that helped the Toronto woman give birth in 2014 at age 56 using donor eggs and donor sperm. (She was 55 at the time of embryo transfer.)

Baratz, who was not the woman’s doctor, said it’s believed she and her son are doing well. “We have not heard otherwise.”

It’s not known whether she is the oldest Canadian woman to deliver after donor eggIVF. In Canada, clinics aren’t obligated to collect or report such statistics. In India, 72-year-old Daljinkder Kaur, who gave birth in May to a healthy boy using anonymous donor eggs, may now hold the world title.

The previous record was held by Maria del Carmen Bousada de Lara of Barcelona, Spain, a single mother who delivered twin boys in 2006, one week before her 67th birthday. She died three years later of stomach cancer, leaving her sons orphaned.

Baratz said women over 50 are seeking assisted reproduction for different reasons. For some, “life got in the way and they decided to make babies later,” he said. “Some are in new relationships and they’re trying to build a child that’s unique to that relationship.” Others are single.

Many Canadian clinics follow the U.S. cutoff, Baratz said. Others use a combined age formula — for example, the couple’s combined ages can’t exceed 110. “If you look at the LGBT community as well, we have to be consistent,” Baratz said. “We want some kind of caregiver for this child. Even if it’s same-sex females or same-sex males, you’d like to know that at least one of them is going to be around longer.”

In Quebec, most fertility clinics draw the line closer to the natural age of menopause (51 or 52), provided the woman is in good health, said Dr. Neal Mahutte, medical director of the Montreal Fertility Centre.

“Ultimately I think we all recognize that the concept of stopping treatment at a certain point makes sense,” he said. “The tricky part is where, exactly, to draw the line, given that any cutoff, no matter where it’s drawn, is on some level arbitrary.”

One challenge, he said, is that it’s not inconceivable a postmenopausal woman who undergoes in vitro fertilization using donor eggs could end up with more embryos than needed, freeze the surplus and then return later, when she’s even older, to use her leftover embryos.

“I don’t know if that happened in the Toronto case,” Mahutte said. “But it’s not uncommon in egg donation cycles to generate multiple, high quality embryos.”

Baratz and others said older mothers can have a greater level of maturity, patience and tolerance than younger mothers.

But prominent bioethicist Arthur Caplan argues too many older would-be parents are being deluded by the “television optimism” of aging and the messages telegraphed by celebrities such as the newly pregnant Janet Jackson, who turned 50 in May. “Of course, what isn’t said is, ‘I have seven nannies and a chauffeur,’” said Caplan, head of medical ethics at New York University’s Langone Medical Center. (Jackson has not said if she used IVF or donor eggs, but according to fertility experts, the monthly chances of natural conception drops to below one in 1,000 by age 45.)

While people are living longer, they don’t necessarily avoid the ravages of old age. “The odds are that you will encounter a health problem that is very significant over 65,” Caplan said.

In addition, older couples seeking donor egg IVF also tend to choose to use the male partner’s sperm. However, growing evidence is linking advanced paternal age (50 or more) with chromosomal abnormalities such as Down syndrome, as well as an increased risk of autism and schizophrenia.

Caplan says he isn’t against parenting by older people. “I know it happens. And for men, they can get things to happen in the bedroom at any age, and you aren’t going to police them,” he said.

“But it’s basically the principle of, protect the best interests of the child,” Caplan said.

“Don’t put the child in a home where the parents won’t live long enough to raise him.”